Healthcare Provider Details

I. General information

NPI: 1205888997
Provider Name (Legal Business Name): WILLIAM R BEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE NW MOB SUITE 200
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

PO BOX 71690
RICHMOND VA
23255-1690
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2300
  • Fax: 804-285-8420
Mailing address:
  • Phone: 804-285-2300
  • Fax: 804-285-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101046574
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101046574
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: